A lobotomy (Greek: lobos: Lobe of brain, tomos: "section") is a form of psychosurgery, also known as a leukotomy (from Greek leukos: clear or white and tomos meaning "section"). It consists of cutting the connections to and from, or simply destroying, the prefrontal cortex. These procedures often result in major personality changes. Lobotomies have been used in the past to treat a wide range of mental illnesses including schizophrenia, clinical depression, and various anxiety disorders. Since the development of such antipsychotic drugs such as Thorazine in the 1950s, lobotomies and other forms of psychosurgery have become generally obsolete.

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History

In 1890, Dr. Sarles performed partial lobotomies on six patients of a psychiatric hospital in Switzerland. He drilled holes into their heads and extracted sections of their frontal lobes. One died after the operation, and another was found dead in a river 10 days after release (whether by accident, suicide, or crime is unknown), but the others exhibited altered behavior.

The first controlled human lobotomy was performed by the Portuguese physician and neurologistAntónio Egas Moniz in 1936. His method involved drilling holes in patients' heads and destroying the tissue connecting the frontal lobes by injecting alcohol into them. Moniz won the Nobel Prize for medicine in 1949 for this work. The procedure was refined by British psychiatrists including Eric Cunningham Dax, and brought to the United States by Drs. Walter Freeman and James W. Watts, who refined Moniz's procedures and changed the name from leukotomy to lobotomy.

Freeman, without the support of Watts, later developed a version that reached frontal lobe tissue through the tear ducts. In his transorbital lobotomy, a mallet is used to force a surgical instrument akin to an ice pick through the thin layer of skull at the top of the eye socket. The pick is then wiggled to damage the frontal lobe. This technique could be performed in a doctor's office rather than in an operating room, and required only a few minutes to perform. Freeman advocated this procedure for patients with even fairly mild symptoms. He personally performed the operation on thousands of people and promoted the idea of lobotomy as a casual procedure, claiming it would one day be as common as dental work.[1]

Lobotomy had long been criticized by the medical profession, as many were repulsed at the idea of deliberately destroying healthy brain tissue. Several cases of lobotomies which significantly damaged the recipients' mental capacity were publicized and cemented the procedure's poor reputation. With the advent of Thorazine in the 1950s, the procedure began to seem barbaric, and rapidly declined. In 1950 lobotomy was banned in the USSR.

In 1977, the U.S. Congress created a National Committee for the Protection of Human Subjects of Biomedical and Behavioral Research to investigate allegations that psychosurgery, including lobotomy techniques, was used to control minorities and restrain individual rights, and that it had unethical after effects. It concluded that, in general, psychosurgery could have positive effects. However, concerns about lobotomy steadily grew, as numerous countries such as Germany and Japan, along with several U.S. states, prohibited it. Lobotomy was legally practiced in controlled and regulated U.S. centers and in Finland, Sweden, the United Kingdom, Spain, India, Belgium and the Netherlands. The practice had generally ceased by the early 1970s, but some countries continued small-scale operations through the late 1980s. In France, 32 lobotomies were performed between 1980 and 1986 according to an IGAS report; about 15 each year in the UK, 70 in Belgium, and about 15 for the Massachusetts General Hospital of Boston.[2]

Scale

Lobotomy was most prevalent in the United States, with approximately 40,000 persons lobotomized, followed by Great Britain with approximately 17,000 and the three Scandinavian countries with a combined figure of approximately 9,300.[3]

Cases

Rosemary Kennedy, sister of President John F. Kennedy, was given a lobotomy when her father complained to doctors about the 23-year-old’s moodiness and growing interest in men. The procedure was personally performed by Dr. Freeman. Instead of producing the desired result, however, the lobotomy reduced Rosemary to an infantile mentality that left her incontinent and staring blankly at walls for hours. Her verbal skills were reduced to unintelligible babble. To avoid political scandal, the nature of Rosemary's affliction was hidden by her father for years, described to the public as the result of mental retardation. Her sister, Eunice Kennedy Shriver, founded the Special Olympics in her honor in 1968.

Howard Dully had a lobotomy at 12, after his stepmother was simply tired of his "youthful defiance". In regards to the long term effects of the operation, at the age of 56 he said, "I've always felt different -- wondered if something's missing from my soul. I have no memory of the operation". Dully would later go on to uncover the story of his own lobotomy, which had not been revealed to him prior.[4]

See also

For an example of the personality changes associated with damage to the frontal lobe not related to a surgical leukotomy, see the famous case of Phineas Gage.